Introducing the Moyo device for intrapartum fetal heart rate monitoring among women with high-risk pregnancies in a low-resource setting: a quasi-experimental study.

objectiveTo assess the effect of introducing the Moyo device for continuous intrapartum fetal heart rate monitoring (FHRM) on the detection of abnormal fetal heart rate patterns and perinatal mortality.

designWe conducted a quasi-experimental quality improvement project using a before-and-after approach. During the preimplementation phase, intermittent FHRM was done using the existing standard of care (Pinard or a hand-held fetal Doppler). In the postimplementation phase, we introduced the Moyo device (Laerdal Global Health, Stavanger, Norway) for continuous intrapartum FHRM. We used the non-participant observation technique to collect data.

settingMbale Regional Referral Hospital in Eastern Uganda, 6 November 2023 to 17 August 2024.

participantsWe enrolled 1544 women with high-risk pregnancies. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was perinatal mortality, defined as death in labour and up to 24 hours postnatal. The secondary outcomes included detection of abnormal fetal heart rates, Apgar scores less than 7 at 1 and 5 min and mode of birth. We conducted generalised linear regression models of the binomial family with a log link and robust variance estimation.

resultsMortality preimplementation was 5.1%; following the introduction of the Moyo device, it fell to 3.2%, a non-statistically significant reduction of 37% (adjusted prevalence ratios (aPRs): 0.63 (95% CI 0.39 to 1.02)). There was a 14.8% increase in the number of women whose fetal heart rate was monitored and documented during the postimplementation period (81.1% vs 95.9%) and detection of abnormal fetal heart rate was increased by 41% (aPR: 1.41 (95% CI 1.10 to 1.82)). The rate of caesarean section deliveries was similar in the preimplementation and postimplementation period (59.5% vs 63.1%, p=0.144). Newborn morbidities were lower in the postimplementation phase compared with the preimplementation phase: Apgar score <7 at 1 min (aPR: 0.67; 95% CI 0.54 to 0.85), Apgar score <7 at 5 min (aPR: 0.57; 95% CI 0.39 to 0.84), transfer of newborn to postnatal ward (aPR: 1.11; 95% CI 1.05 to 1.17), and transfer of newborn to the neonatal unit (aPR: 0.72; 95% CI 0.59 to 0.87).

conclusionsIntroduction of the Moyo device for continuous FHRM was associated with a reduction in perinatal morbidity among women with high-risk pregnancies. We recommend a stepped-wedge trial to evaluate the cost-effectiveness of scaling up the use of Moyo in lower-health facilities.